Susannah, too, wanted to make sure everyone clearly understood and was as comfortable as possible with what she was asking of them. She knew that going over everything once or twice was usually never enough. It had to be repeated several times. That was why it was necessary for those who would work with Adam to be so carefully trained. "Yes, especially at the beginning. We want him to learn that crying and other problem behaviors will no longer function to get him out of demands. As Adam becomes more tolerant of the instructional demands we begin to fade the reinforcers. We would only use praise and not an edible or tangible reinforcer or a preferred activity. He would only get those if he does the task seated in the chair and he was not crying or acting inappropriately. Then we may only reinforce every other time he's able to demonstrate a skill, then every third time and so on. This is part differential reinforcement. We would also start to expand the time he has to spend doing the task. At first we might only try to get him near the chair. Once that has been successfully incorporated we would try to get him to sit in the chair for a second or two then for a minute and so on. Once we get him to sit in the chair successfully, we will ask him to do a task."

"What is it with these goals and tasks? He's a baby! What kind of tasks do you expect him to do!" Blair was outraged.

"For Christ's sake, Blair! What do you think she's going to ask him to do, perform brain surgery!" Kevin hated her attitude.

"Don't raise your voice to me, Kevin! I have a right to voice my opinion and ask questions. I don't remember hearing anyone say you were in charge here." Blair shot back, her own voice raised.

"Kevin, Blair, can we please get through this without you two bickering," Viki chastised.

Susannah held her hand up. "Let's calm down. I want all of you to feel free to ask any kind of questions you want. I want you to feel as comfortable as possible with this before we start working with Adam." Susannah quickly tried to contain the situation before it escalated.

Sam cringed at the word "training." He still hated every aspect of this. Sam wanted to protest more, but he was suddenly so tired. He didn't have the energy to say much. He was glad Blair was there. He agreed with everything that she said, so far.

"In answer to Blair's question, the tasks Adam will be asked to do are things like simple one step instructions, commands like 'come here.' Or we say 'do this' . . . sit down, stand up, clap hands. He'd be asked to touch body parts . . . where the instruction or would be 'touch,' head, nose, ear, etc. There would be some receptive language action commands, 'show me' . . . eating, drinking, clapping, waving or various body parts. Imitation is very important. When we model the way to do a skill to a child he first must be able to imitate. Early imitation skills are 'do this' . . . clap hands, stomp feet, stand, etc. These are gross motor skills. The fine motor skill will probably be more difficult for him. Those would be things like pointing, holding a crayon, opening and closing his hands, making a peace sign, working a doorknob, things like that. We will work on matching skills, by saying 'match' and having him match an object to an object, a picture to a picture, a color to a color and so on. Verbal imitation would just start out with sounds and depending on how he does with that, progress to words. The fact that Adam is already vocal and makes sounds is very encouraging. Some children with autism are almost mute."

Susannah knew they would like hearing this next part. "Some of the things we may ask Adam to do at the beginning will be things highly preferred activities. They will be things we know he wants to do anyway, like eating an M&M or playing with a favorite toy or even stimming. This will increase the chance of compliance thus increasing his success. You may also want to quickly insert an Sd if a response is about to happen that you can't control. For example, if on his own, Adam starts to place a block on the floor you would quickly say 'put the block on the floor.' This way he is actually being compliant and gets a reinforcer for his success."

"And he would be reinforced for everything at the beginning, so he knows he succeeded," Viki wanted to make sure of this.

Susannah could tell that this part of the program was very important to most of them. They were grasping on to the part of the program that would be pleasurable for Adam. The fact that they were asking about that aspect the program over and over again told Susannah that they needed a lot of reassurance. She had no problem giving it to them.

"Yes, at the beginning. Eventually the praise we use for prompted responses would not be as great or animated as for unprompted ones. We would use praise like 'okay' 'yep,' 'that's right.' Phrases like that. We would save things like 'yaaayyy great job!' for when he is able to comply on his own. At the beginning we use them for all correct responses, prompted or unprompted." Susannah emphasized the word all.

Susannah could tell that everyone was pretty wiped out. She wanted to make sure to get in a few more points. "Let's go over to the table," she stood up and waved in the direction of the little square table that had been set up in the corner of the room.

"I don't think it's a good idea to conduct the training in Todd's room or the day room. There are too many distractions there and I want him to associate those places with rest and play and the freedom to do what he pleases, up to a point. I think my office has the least distractions. You'll notice the table is pushed up against the corner. We need to manipulate Adam's environment to make it difficult for him to leave the table. We also need to offer him the fewest distractions. By having the wall surrounding two sides of the table we accomplish this."

Susannah then showed them some of the teaching materials. She showed them how Adam would be asked to place one of the brightly colored plastic cups into it's matching partner, the same for the bowls and blocks. "At first we would only have two items for him to match. Then we increase his choices." She demonstrated the blocks being put into a bucket and showed them some puzzles with large wooden pieces instead of small cardboard ones. She demonstrated how the various shapes would be placed on their corresponding shapes on the canvas mat. There were some stacking toys, a shape sorter, and a jack-in-the-box and a spin top. In addition to the edible ones, reinforcers included soap bubbles with a wand, stickers, various strips of different kinds of material, little Hot Wheels cars and some wooden Thomas the Tank Engine figures.

Téa held up a plastic board with little circles attached to it with Velcro. "What's this?"

"That's a token board. Adam won't understand its purpose at the beginning. Once he can grasp the concept of a secondary reinforcement, meaning he gets a token for complying and those tokens can be exchanged for things he wants, like a break or an edible or tangible reinforcer, we will begin using it. There are more things we will try, but this should be enough to start," Susannah explained.

"How do we know when to use a full, hand-over-hand, physical prompt and when not to use one?" Viki asked.

"At the beginning and whenever a new skill is taught it usually requires a hand-over-hand prompt. It may also be necessary if a skill is forgotten or if there is non-compliance with a skill we know has already been learned. When you are dealing with a skill that has already been taught you give the Sd. Then you wait a couple of seconds for him to get it on his own. If he doesn't, you give the Sd again and wait a couple of more seconds. If he still doesn't comply you would then prompt on the third delivery of the Sd. You start with the least invasive prompt, which may be just a tap on the elbow or even a look. You might use what is called a positional prompt."

Susannah began to demonstrate by placing some of the small objects on the table. "Let's say you put out a Hot Wheels car, a small plastic dog and a small plastic shoe out on the table and say 'show me car.' You might place the car closer to the child than the other two objects when you put them out. Or in the same situation you might move your hand close to the car when you ask for it. A positional prompt gives the child a clue. You might also use a gestural prompt. That would be subtly pointing, glancing or motioning to the correct response such as the car, in the example above. You do have to be careful not to do these things inadvertently. You would be amazed at how quickly Adam will pick up on the tiniest glance or hand movement you give the desired object. So you want to fade positional prompts quickly. The aim is to fade all prompts as quickly as possible. We don't want Adam to become prompt dependent," Susannah cautioned.

"Susannah this is much more complicated than I had anticipated it would be," Viki still looked and sounded worried.

"I know. It's perfectly normal to feel overwhelmed at the beginning. Please don't be afraid of making mistakes. It is only natural for that to happen in the beginning," Susannah repeated.

"Don't be afraid to make mistakes! This is a little boy we're talking about not a test we are being asked to take." Blair couldn't believe Susannah's seemingly callous attitude.

"Susannah, are you sure any mistakes won't cause any lasting to harm to Adam?" Viki was still very afraid of doing the wrong thing. She was even more concerned now because of Blair's comment.

"No, not things like using the wrong kind of prompt once or twice. It may temporarily confuse him, but it shouldn't cause any major problems," Susannah once again reassured them.

"Doctor Hanen, I remember when I held the ball up for Adam and asked him 'what do you want' you told me to only say it once and not repeat it. I have two questions. Was the question 'what do you want' considered the Sd and do we never repeat the Sd?" Téa asked. Like the others she was feeling insecure in her understanding of ABA.

"That's a great question Téa," Susannah praised. "Yes, that was the Sd and no, you don't repeat it until the child has given a response. The things to remember about the delivery of the Sd is that first you need to establish attention. The Sd should be clear and precise. If the Sd is for a new skill you would model or prompt at the same time you are giving the Sd. If, let's say, the Sd is 'do this!' and you want him to place a block in the bucket. As you say 'do this,' you place the block in the bucket exactly as you want Adam to do it. If you want him to stand up you stand up first. This is how you model a new skill for him."

Susannah pointed to the huge stacks of forms. "This is the part that you may find you come to like the least," Susannah smiled and continued. "We have to carefully document virtually every move Adam makes. We need to see what works, what doesn't, as far as reinforcers and prompts go, what skills are more difficult for him than others, how many trials we do, what is accomplished with each trial . . ."

Unfortunately, Susannah had to go on and on explaining the charts graphs and forms. She could see they were all relieved when she was finished. Susannah took a deep breath and stated, "I know you are all feeling overwhelmed, but you will find that after a while it comes to you naturally. It really becomes a quick checklist while you are working with him and after each session you do a little more extensive documenting. You also may find it helpful to put a few pieces of adhesive tape on your pant leg or skirt and jot down some quick notes on that until you get used to working at the table with Adam. Sometimes having clipboards and sheets of paper at the table can add to confusion, at the beginning."

"And we always thought lawyers had a lot of paper work, huh Sam?" Téa joked, looking in Sam's direction.

He didn't even crack a smile. In fact he didn't seem to have even heard her. Téa was extremely worried about him, and not sure at all about him becoming Todd's co-guardian at this time.

"Are there any more questions?" Susannah asked.

"Yeah, I have one," Kevin spoke up. "You said we do a lot of this documentation after the session. I don't know about anyone else, but I think I might have a problem remembering the important details of the session."

"Susannah, now that Kevin has mentioned it, I'm not entirely confident that I will either," Viki concurred.

"I understand that can be a problem, that is why, Viki with your permission, I would like to video tape Adam's sessions. Audio recordings will not really help in this."

Viki looked around the room. Even Sam and Blair had no objection to this. "Yes, please, video tape Adam if you think it will help," Viki agreed.

"Yes, I do. It is often used in ABA sessions." Susannah was hoping to put many of the alters on video tape, eventually, when Todd was ready to meet them. She knew she didn't have to worry about that for a while.

"Any more questions?" Susannah asked. She looked around. "Okay, then why don't we go see if Adam is awake. I'm sure things have been quiet or they would have let me know."

Nancy told them Adam woke up and was in the day room. A smile came to all their faces, even Sam's, when they walked into the room. Adam was sitting, cross-legged, on the floor, chewing on his blanket as he clutched it in his hand. His sideways stare was wide as he watched the tape of Toy Story that Téa had brought him. Frank, Don and Terry were all attentively watching along with him. Terry and Frank each sat in a chair, near him. Don sat next to him on the floor.

The adults turned to everyone who had entered the room, Adam's eyes stayed glued to the television.

"It's the second time he's watching it. He woke up and started to run around. We guided him in here and started to play the tape. He immediately became interested. He started to cry when the tape ran out the first time. We thought it best to keep him calm for now." Don filled them in.

"Yes, you did the right thing," Susannah praised and then instructed, "Let the movie finish and then we'll cope with his reactions when we shut it off."

"Has he eaten?" Viki inquired.

"He had some juice and some mac and cheese," Terry informed them and then added, "although his clothes probably got more of it on them then he got in him."

"Did you try to spoon feed him?" Téa asked.

"Yep. He was completely resistant to it, so we let him eat his way and then changed him," Frank answered. Frank turned to Viki and said, "By the way, those sweat suits were delivered. They're great! I think he's gonna to be going through three or four changes a day, at least on the shirts."

Viki was pleased they arrived. "Just let me know if you need more. I'll have them sent over," she promised.

"Susannah, I brought a couple of Happy Meals for him. They're in the fridge. Do you think I can try to interest him in them?" Kevin asked.

"Oh! I did want to try those with him," Don sighed, "the cafeteria worker put some stuff in front of them and I didn't see the bags and forgot all about them."

"Why don't one of you heat them a little for him and we'll see if we can get him interested," Susannah suggested.

Adam did not seem to notice all the people in the room with him. Nothing was distracting him from the movie. His concentration was intense. Even though it didn't appear he wasn't seeing the screen, they could tell he was.

Téa raised a question. "Is it common for children with autism to even watch TV peripherally?"

"Yes, many use peripheral vision exclusively. Adam may find it very uncomfortable to look at anything head on. He is seeing what he needs to see. His peripheral vision is probably very acute," Susannah suspected.

Kevin sat down on the floor next to Adam. "Hey Adam, you really like that movie, huh?" Kevin put his arm around Adam's shoulders. Adam squirmed a little. He never took his eyes off the screen.

Don brought in the food. He handed the small McNugget box to Kevin. Kevin picked one up and held it out near Adam's face. Adam didn't budge. He didn't turn in the direction of the food or make any attempt to take it from Kevin.

"Guess, he's just not a chicken lover," Kevin smiled and was about to put it back in the box when it slipped onto the floor. "Uh oh!" Kevin said in an animated, singsong voice. Viki handed him a napkin. Kevin wrapped the small nugget in it and got up and threw it in the trash. He broke off a small piece of the hamburger and held it near Adam's face. Again there was no reaction.

"I think all his concentration is on the movie," Terry, observed.

Woody and Buzz were almost back with Andy. They allowed Adam to see the movie to the end one more time. When it was over Susannah shut off the TV.

"Uh oh!" Adam said in an exact imitation of the way Kevin had said it almost twenty minutes ago.

"Adam! You can talk!" A shocked Téa proclaimed.

"Hey Adam! Say it again!" Kevin coaxed. He could not contain his excitement.

"AAAHHH!" Adam protested with his usual vocalizations. He toe-walked up to the TV and hit it, trying to make the movie come back on again.

"He spoke! Susannah you heard him." Kevin then turned to Frank and Terry, who had also been standing near Adam when he spoke. "Come on, you guys heard him! Téa and I heard him. He spoke!"

"It's called delayed echolalia. Children with autism often repeat exactly what they heard in the same exact intonation that they heard it in. There is echolalia, when the child repeats it immediately or delayed echolalia, when the child does it some time after he heard it. Sometimes they repeat it endlessly and sometimes they never say it again. It is encouraging that Adam could do that. It is a good predictor of success in learning language. It is also encouraging that he used it appropriately," Susannah happily informed them.

Kevin tried again. He repeated "uh oh" in exactly the way he had previously said it.

"Come on Adam. 'Uh oh!' Come on, you can do it! 'Uh oh!' Téa tried.

"Téa, Kevin, children with autism don't learn that way. They . . ." Susannah stopped talking and they all turned in Adam's direction when they heard the TV go on again.

"Did you turn it back on?" Susannah directed her question to Frank who had been standing near the TV with Adam.

Frank's smile was huge. "Nope, he did it himself."

All eyes were on Adam. "He turned the TV on by himself?" Viki asked, unbelievingly.

"He sure did!" Frank responded, still smiling at Adam's achievement.

"Ahhhh!" Adam said and hit the screen with the palm of his hand. He couldn't understand why something other than Toy Story was on the screen.

"Turn it off," Susannah instructed. "I want to see if he really knows how to turn it on or it was accidental."

Frank did as Susannah asked.

"AAAHHHH!" Adam protested loudly and looked angry. He went right for the power button and turned it back on.

"Yaaayyyy! Way to go, Adam!" Téa praised and rushed to him and tickled the back of his neck. "I love the way you turned on the TV." Téa did not have to force any of the animation that was in her voice. She was thrilled.

Adam smiled and gave a small laughed as Téa continued to tickle his neck. The look of pure joy on his face was matched by the same look on Téa's. She could not believe that she had gotten this child to not only smile again, but also laugh.

"I love the way you laugh! Oh Adam, I love your laugh!" A tear of joy cascaded down Téa's cheek as she praised him.

She was not the only one. Even though Blair wished it had been she to get him to smile and laugh she was happy to see it. She didn't for one-minute think Téa was genuine in her happiness or affection for Adam, but it didn't matter. What mattered was that this part of Adam had been reached. 'If Téa can do it, so can I,' Blair thought.

Viki squeezed Sam's hand. "Honey, our Adam laughed. He turned on the TV!"

Sam bit his lower lip. He could not speak right now. He just nodded repeatedly.

Adam turned his attention back to the TV. He hit the screen again.

"Can I put the movie back on for him?" Kevin asked.

"No, he has already been reinforced for that," Susannah replied.

Kevin was disappointed. He felt Adam deserved a big reward for what he had done.

"I can't believe he figured out how to work the television so quickly," Viki stated.

"Maybe that means your diagnosis is wrong and he's not autistic after all." Blair said this hopefully, not accusingly.

Susannah noticed a similar hope in the eyes of all of them. She hated to take that away from them, however she was certain of her diagnosis. "Often children with autism are good with electronics. Electronics, unlike people, are something they can understand. Some children with autism can easily program VCRs and yet can't understand how to turn a doorknob. This still shows that Adam has some good reasoning power and may be able to learn some things quickly," Susannah added encouragingly.

Adam was still trying to get the movie to come back on. He was getting frustrated.

"I would like to get Adam to my office for the training session. It would be a short one, just an hour or so. Are you ready for a training session with Adam?" Susannah posed the question to all of them asked.

Sam's happiness over the situation was short-lived. "Can't you just let him enjoy himself for a few Goddamn minutes!" Sam's angry words were directed at Susannah.

"Sam, every minute that we have to work with Adam is precious. He has demonstrated a lot of potential today. I truly believe we can give this child functional communication. I think he needs to begin being in a tightly structured environment right now." Susannah's voice had a tinge of weariness in it. She knew how difficult it would be to have Sam fight her every step of the way.

Sam looked toward Viki. "Honey, he does have to start sometime." Viki's tone was almost apologetic. Then she thought of Adam's achievements and she knew she wanted to them built on. "I think it's a good idea for his program to be started as soon as possible," Viki stated more firmly. She took a deep breath. "I'm ready, Susannah," Viki said nervously.

"So am I," Téa spoke up next.

"You can count me in," Kevin added.

Blair cast Sam a quick look. She rolled her eyes to let Sam know what she thought. She then looked directly at Téa and said, "I'm ready too. If Adam has to go through this I want to be a part of it."

"Honey?" Viki turned to Sam.

Sam did not want to be a part of this.

"Sam we should be there for Adam. He may need us." Blair said this hoping Sam understood that she meant Adam needed them to protect him from the others.

Viki did not like sudden kinship between Blair and Sam. Viki wasn't jealous. She was scared. She did not trust Blair's motives and she knew how Blair had a tendency to isolate people with her 'it's us against the world" attitude. Viki also realized how vulnerable Sam was right now. She took Sam's hand. "Honey, Adam needs us to help give him a way to let us know what he wants and what he doesn't like or what hurts him. Don't you think it will help him to be able to do that?"

Sam hardly heard Viki. He was thinking about what Blair had said earlier. 'Yes! I have a chance to protect Adam. I will not blow another chance and allow this child to be hurt.' Sam thought to himself. "Fine! I'll go. Just don't ask me to join in and torture that child," Sam stated firmly.

Viki, Téa and Kevin all held back on responding to Sam's last statement. They did not want to set him off. Susannah hoped once he saw some results he would become more invested in Adam's program, but she had considerable doubts. Sam hatred of this program was way out of proportion. He was using it as the enemy. His hatred for it and fear of it were becoming obsessive. Still, Susannah was happy that at least he agreed to observe.

Téa too was relieved that Sam calmed down and agreed to observe Adam's first formal session. Yet, Téa could not shake the uneasy feeling she had. It was not only Sam's "new" closeness to Blair, 'something really bad is happening to Sam,' Téa thought as a sudden chill ran down her spine. Téa had a bad feeling and felt afraid for Todd. 'Sam loves Todd more than his own life. He would never do anything that would hurt him,' Téa said to herself, trying to shake her fears away. Téa looked at Sam as he looked at Adam. She saw so much love pouring out of his eyes. 'No, Sam would never do anything to hurt him,' Téa thought. Still the uneasy feeling remained. Téa thought back to the sight of Adam's smile and the sound of his laughter. 'No! No matter how Sam feels he would never, not even unintentionally, do anything that would hurt Adam or any of them, Téa told herself firmly. She hoped all would go well with Adam's first formal session.

TO BE CONTINUED